Healthcare Provider Details

I. General information

NPI: 1386576858
Provider Name (Legal Business Name): KELLY SCHUCK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 PINE DR
RIDGWAY CO
81432-9682
US

IV. Provider business mailing address

782 PINE DR
RIDGWAY CO
81432-9682
US

V. Phone/Fax

Practice location:
  • Phone: 205-940-1895
  • Fax:
Mailing address:
  • Phone: 205-940-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: